Imaging findings of flexion type of hangman's fracture; an attempt for a more objective evaluation with newly introduced scoring system

Taif, Sawsan; Menon, K. Venugopal; Alrawi, Asif; Alnuaimi, Ahmed Sameer; Mollahalli, Kishore K; Ghafri, Khalifa Al

doi:10.1259/bjr.20160793

Cited by 3 publications

(3 citation statements)

References 25 publications

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“…They also use the C3 body chip fracture at the antero-rostral body and the kyphosis of the C2–3 junction as the indicators for the flexion injuries. The present authors do not support this view entirely but use additional radiological parameters, particularly evidence of tensile failure of the PLC at C1–2 as evidence of flexion type of Hangman’s injury [40,41]. The criteria for diagnosis of the flexion injury are illustrated in earlier publications by the author.…”

Section: Clinical Relevance To Hangman’s Injuries Of the Cervical Spinementioning

confidence: 86%

Mechanically Relevant Anatomy of the Axis Vertebra and Its Relation to Hangman’s Fracture: An Illustrated Essay

Menon

2019

Neurospine

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To describe the biomechanically relevant anatomy of the Axis vertebra and the load transfer patterns within the bone, and on that basis, to postulate its mechanism of injury, a literature review was conducted of the anatomy and biomechanics of Axis fractures. Two hypotheses have been presented: the internal gear hypothesis and the leaf spring hypothesis. Both are based on the trabecular anatomy of the vertebra and its load transmission patterns. The relationship of the Axis with Hangman’s injury is also discussed. According to the leaf spring hypothesis, the C2 pedicle corresponds to the shackle in the assembly and constitutes the weak link. The trabecular architecture of the Axis is such that the primary compression of the trabeculae is directed from the superior facet to the C2–3 endplate, with few trabeculae directed to the inferior facet. Along with the trabecular void in this area, this renders the isthmus vulnerable to trauma. The isthmus of the Axis is biomechanically susceptible to injury due to its unique anatomy in relation to the whole cervical spine and the internal load transmission patterns of the bone. The author suggests that in the flexion type of Hangman’s injury, the C1–2 posterior ligaments are disrupted and need to be addressed.

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Section: Clinical Relevance To Hangman’s Injuries Of the Cervical Spinementioning

confidence: 86%

Mechanically Relevant Anatomy of the Axis Vertebra and Its Relation to Hangman’s Fracture: An Illustrated Essay

Menon

2019

Neurospine

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“…Inclusion criteria were: (1) patients were medically confirmed of Hangman’s fractures, which were defined as axis ring fractures with or without displacement and/or angulation at C2/3 level [ 1 , 3 , 10 , 12 ]; (2) patients with complete imaging studies, including X-rays, axial plane CT scans, sagittal and coronal plane reconstructions, and three-dimensional reconstructions of cervical spine, and all CT images were acquired using at least a 64-slice multidetector CT scanner [ 16 ]. Patients with congenital anomalies, infections, or tumors in the upper cervical spine were excluded [ 7 , 23 ].…”

Section: Methodsmentioning

confidence: 99%

Detailed observation of anatomical location and pattern in Hangman’s fracture based on computed tomography three-dimensional reconstruction

Wang

2023

J Orthop Surg Res

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Objective To observe the precise anatomical location and pattern of the fracture lines in Hangman’s fracture. Methods Three-dimensional computed CT images of 210 patients with Hangman’s fracture were collected. According to the involvement of anatomical structures, the injuries were classified into facet joint injury and pure bony injury. The C2 ring was also divided into: anterior, middle, and posterior elements. The anatomical structures involvement and fracture patterns were observed. Result Total 520 anatomical structures injuries were involved in 210 patients Hangman’s fractures, including 298 facet joints injuries (57.3%) and 222 bony injuries (42.7%). The most common facet joints injury was superior articular facet injury of C2, and the most common pure bony injury was pediculoisthmic component fracture. The injuries of anterior element (60.6%) were more common than that of middle (20.4%) or posterior (19.0%) element. One injury in anterior element on one side and another injury located in the anterior, middle or posterior element other side was the most common fracture pattern. Injury of middle element on one side with another injury located in the middle or posterior element could be also observed. Conclusion In Hangman’s fractures, fracture lines could occur in any part of C2 ring. Facet joints injuries were more common than pure bony injuries, and the injuries of anterior element were also more common than that of middle or posterior element. The high prevalence of facet joints injuries means that most of Hangman’s fractures may be involved with intra-articular injuries.

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“…Patients were included if they ful lled all the 2 criteria: (1) patients were medically con rmed of axis ring fractures with bilateral fracture lines through any part of the bony ring, including pediculoisthmic component (PIC) fractures, posterior wall of vertebral body fractures, superior or inferior articular facets, or lamina [14,15]; (2) patients with complete imaging studies, including X-rays, axial plane computed tomography (CT) scans, sagittal and coronal plane reconstructions, and three-dimensional reconstructions of cervical spine, and all CT images were acquired using at least a 64-slice multidetector CT scanner [5]. Patients with congenital anomalies, infections, or tumors in the upper cervical spine were excluded [13,16].…”

Section: Methodsmentioning

confidence: 99%

Detailed observation of axis ring fractures using computed tomography: a retrospective analysis of 202 cases

Wang

et al. 2020

Preprint

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Background: There is a dearth of research observing the precise anatomical location, pattern, and frequency of the fracture lines in axis ring fractures based on large size sample database and deducing the possible injury mechanism for such fractures. The study aimed to observe the anatomical features of axis ring fractures and evaluate the probable mechanism of injury.Methods: 202 patients with axis ring fractures were identified. According to the involvement of anatomical structures, the axis ring injuries were classified into facet joint injury and pure bony injury. The axis ring was also divided into: anterior, middle, and posterior elements. The anatomical structures involvement and fracture patterns of such fractures were observed using CT. Result: 501 anatomical structures of the axis ring were involved in 202 patients, including 288 facet joints injuries and 213 bony injuries. For facet joints injuries, the most common injuries were superior articular facet injuries, and for pure bony injuries, the most common injuries were pediculoisthmic component fractures. In regard to different element of the axis ring, the injuries of anterior element were more common than that of middle or posterior element. Most of (76.2%) axis ring fractures were asymmetrical, with different elements of the axis ring damaged on different side. Conclusion: In axis ring fractures, fracture lines could occur in any part of the ring. Facet joints injuries were more common than pure bony injuries, and the injuries of anterior element were more common than that of middle or posterior element. The probable mechanism of such injuries might be hyperextension and axial load, with an additional rotational load.

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Imaging findings of flexion type of hangman's fracture; an attempt for a more objective evaluation with newly introduced scoring system

Cited by 3 publications

References 25 publications

Mechanically Relevant Anatomy of the Axis Vertebra and Its Relation to Hangman’s Fracture: An Illustrated Essay

Mechanically Relevant Anatomy of the Axis Vertebra and Its Relation to Hangman’s Fracture: An Illustrated Essay

Detailed observation of anatomical location and pattern in Hangman’s fracture based on computed tomography three-dimensional reconstruction

Detailed observation of axis ring fractures using computed tomography: a retrospective analysis of 202 cases

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